PEDIATRIC DISORDERS b.

Meropenem
CMPA 412 c. Metoprolol
PRACTICE Q&A d. Deferoxamine

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. The clinic nurse instructs parents of a child

HEMATOLOGICAL DISORDERS with sickle cell anemia about the precipitating
factors related to sickle cell crisis. Which, if
1. The nurse analyzes the laboratory results of identified by the parents as a precipitating
a child with hemophilia. The nurse factor, indicates the need for further
understands that which result will most likely instruction?
be abnormal in this child?
a. Stress
a. Platelet count b. Trauma
b. Hematocrit level c. Infection
c. Hemoglobin level d. Fluid overload
d. Partial thromboplastin time
6. A 10-year-old child with hemophilia A has
2. The nurse is providing home care slipped on the ice and bumped his knee. The
instructions to the parents of a 10-year-old nurse should prepare to administer which
child with hemophilia. Which sport activity prescription?
should the nurse suggest for this child?
a. Injection of factor X
a. Soccer b. Intravenous infusion of iron
b. Basketball c. Intravenous infusion of factor VIII
c. Swimming d. Intramuscular injection of iron using the
d. Field hockey Z-track method

3. The nursing student is presenting a clinical 7. The nurse is instructing the parents of a
conference and discusses the cause of child with iron deficiency anemia regarding
β-thalassemia. The nursing student informs the the administration of a liquid oral iron
group that a child at greatest risk of developing supplement. Which instruction should the
this disorder is which of these? nurse tell the parents?

a. A child of Mexican descent a. Administer the iron at mealtimes.

b. A child of Mediterranean descent b. Administer the iron through a straw.
c. A child whose intake of iron is extremely c. Mix the iron with cereal to administer.
poor d. Add the iron to formula for easy
d. A breast-fed child of a mother with chronic administration.
anemia
8. Laboratory studies are performed for a child
4. A child with β-thalassemia is receiving suspected to have iron deficiency anemia. The
long-term blood transfusion therapy for the nurse reviews the laboratory results, knowing
treatment of the disorder. Chelation therapy is that which result indicates this type of anemia?
prescribed as a result of too much iron from
the transfusions. Which medication should the a. Elevated hemoglobin level
nurse anticipate to be prescribed? b. Decreased reticulocyte count
c. Elevated red blood cell count
a. Fragmin
d. Red blood cells that are microcytic and ~~~~~~~~~~~~~~~~~~~~~~~~~~
hypochromic ONCOLOGICAL DISORDERS
(Leukemia & Wilm’s Tumor)
9. The nurse is reviewing a health care
provider’s prescriptions for a child with sickle 1. The mother of a 4-year-old child tells the
cell anemia who was admitted to the hospital pediatric nurse that the child’s abdomen seems
for the treatment of vaso-occlusive crisis. to be swollen. During further assessment, the
Which prescriptions documented in the child’s mother tells the nurse that the child is eating
record should the nurse question? Select all well and that the activity level of the child is
that apply. unchanged. The nurse, suspecting the
possibility of Wilms’ tumor, should avoid
a. Restrict fluid intake. which during the physical assessment?
b. Position for comfort.
c. Avoid strain on painful joints. a. Palpating the abdomen for a mass
d. Apply nasal oxygen at 2 L/minute. b. Assessing the urine for the presence of
e. Provide a high-calorie, high-protein diet. hematuria
f. Give meperidine, 25 mg intravenously, c.. Monitoring the temperature for the presence
every 4 hours for pain. of fever
d. Monitoring the blood pressure for the
10. The nurse is conducting staff in-service presence of hypertension
training on von Willebrand’s disease. Which
should the nurse include as characteristics of 2. The nurse analyzes the laboratory values of
von Willebrand’s disease? Select all that apply. a child with leukemia who is receiving
chemotherapy. The nurse notes that the platelet
a. Easy bruising occurs. count is 19,500 mm3 (19.5 Â 109 /L). On the
b. Gum bleeding occurs. basis of this laboratory result, which
c. It is a hereditary bleeding disorder. intervention should the nurse include in the
d. Treatment and care are similar to that for plan of care?
hemophilia.
e. It is characterized by extremely high a. Initiate bleeding precautions.
creatinine levels. b. Monitor closely for signs of infection.
f. The disorder causes platelets to adhere to c. Monitor the temperature every 4 hours.
damaged endothelium. d. Initiate protective isolation precautions.

3. The nurse is monitoring a 3-year-old child

for signs and symptoms of increased
intracranial pressure (ICP) after a craniotomy.
The nurse plans to monitor for which early
sign or symptom of increased ICP?

a. Vomiting
b. Bulging anterior fontanel
c. Increasing head circumference
d. Complaints of a frontal headache

4. A 4-year-old child is admitted to the

hospital for abdominal pain. The mother
reports that the child has been pale and
excessively tired and is bruising easily. On ~~~~~~~~~~~~~~~~~~~~~~~~~~
physical examination, lymphadenopathy and GASTROINTESTINAL DISORDERS
hepatosplenomegaly are noted. Diagnostic
studies are being performed because acute 1. The clinic nurse reviews the record of an
lymphocytic leukemia is suspected. The nurse infant and notes that the health care provider
determines that which laboratory result has documented a diagnosis of suspected
confirms the diagnosis? Hirschsprung’s disease. The nurse reviews the
assessment findings documented in the record,
a. Lumbar puncture showing no blast cells knowing that which sign most likely led the
b. Bone marrow biopsy showing blast cells mother to seek health care for the infant?
c. Platelet count of 350,000 mm3 (350 Â 109
/L) a. Diarrhea
d. White blood cell count 4500 mm3 (4.5Â b. Projectile vomiting
109 /L) c. Regurgitation of feedings
d. Foul-smelling ribbon-like stools
5. Which specific nursing interventions are
implemented in the care of a child with 2. An infant has just returned to the nursing
leukemia who is at risk for infection? Select all unit after surgical repair of a cleft lip on the
that apply. right side. The nurse should place the infant in
which best position at this time?
a. Maintain the child in a semiprivate room.
b. Reduce exposure to environmental a. Prone position
organisms. b. On the stomach
c. Use strict aseptic technique for all c. Left lateral position
procedures. d. Right lateral position
d. Ensure that anyone entering the child’s
room wears a mask. 3. The nurse reviews the record of a newborn
e. Apply firm pressure to a needle-stick area infant and notes that a diagnosis of esophageal
for at least 10 minutes. atresia with tracheoesophageal fistula is
suspected. The nurse expects to note which
most likely sign of this condition documented
in the record?

a. Incessant crying
b. Coughing at nighttime
c. Choking with feedings
d. Severe projectile vomiting

4. The nurse provides feeding instructions to a

parent of an infant diagnosed with
gastroesophageal reflux disease. Which
instruction should the nurse give to the parent
to assist in reducing the episodes of emesis?

a. Provide less frequent, larger feedings.

b. Burp the infant less frequently during
feedings.
c. Thin the feedings by adding water to the 9. The nurse is preparing to care for a child
formula. with a diagnosis of intussusception. The nurse
d. Thicken the feedings by adding rice reviews the child’s record and expects to note
cereal to the formula. which sign of this disorder documented?

5. A child is hospitalized because of persistent a. Watery diarrhea

vomiting. The nurse should monitor the child b. Ribbon-like stools
closely for which problem? c. Profuse projectile vomiting
d. Bright red blood and mucus in the stools
a. Diarrhea
b. Metabolic acidosis 10. Which interventions should the nurse
c. Metabolic alkalosis include when creating a care plan for a child
d. Hyperactive bowel sounds with hepatitis? Select all that apply.

6. The nurse is caring for a newborn with a a. Providing a low-fat, well-balanced diet.
suspected diagnosis of imperforate anus. The b. Teaching the child effective
nurse monitors the infant, knowing that which hand-washing techniques.
is a clinical manifestation associated with this c. Scheduling playtime in the playroom with
disorder? other children.
d. Notifying the health care provider (HCP) if
a. Bile-stained fecal emesis jaundice is present.
b. The passage of currant jelly–like stools e. Instructing the parents to avoid
c. Failure to pass meconium stool in the first administering medications unless
24 hours after birth prescribed.
d. Sausage-shaped mass palpated in the upper f. Arranging for indefinite home schooling
right abdominal quadrant because the child will not be able to return to
school.
7. The nurse admits a child to the hospital
with a diagnosis of pyloric stenosis. On
assessment, which data would the nurse expect
to obtain when asking the parent about the
child’s symptoms?

a. Watery diarrhea
b. Projectile vomiting
c. Increased urine output
d. Vomiting large amounts of bile

8. The nurse provides home care instructions

to the parents of a child with celiac disease.
The nurse should teach the parents to include
which food item in the child’s diet?

a. Rice
b. Oatmeal
c. Rye toast
d. Wheat bread
 b. “The child should not receive any hepatitis
~~~~~~~~~~~~~~~~~~~~~~~ vaccines.”
RESPIRATORY DISORDERS c. “The child will receive all of the
immunizations except for the polio series.”
1. A10-year-old child with asthma is treated d. “The child will receive the recommended
for acute exacerbation in the emergency basic series of immunizations along with a
department. The nurse caring for the child yearly influenza vaccination.”
should monitor for which sign, knowing that it
indicates a worsening of the condition? 5. The emergency department nurse is caring
for a child diagnosed with epiglottitis. In
a. Warm, dry skin assessing the child, the nurse should monitor
b. Decreased wheezing for which indication that the child may be
c. Pulse rate of 90 beats/minute experiencing airway obstruction?
d. Respirations of 18 breaths/minute
a. The child exhibits nasal flaring and
2. The mother of an 8-year-old child being bradycardia.
treated for right lower lobe pneumonia at b. The child is leaning forward, with the
home calls the clinic nurse. The mother tells chin thrust out.
the nurse that the child complains of c. The child has a low-grade fever and
discomfort on the right side and that ibuprofen complains of a sore throat.
is not effective. Which instruction should the d. The child is leaning backward, supporting
nurse provide to the mother? himself or herself with the hands and arms

a. Increase the dose of ibuprofen. 6. A child with laryngotracheobronchitis

b. Increase the frequency of ibuprofen. (croup) is placed in a cool mist tent. The
c. Encourage the child to lie on the left side. mother becomes concerned because the child
d. Encourage the child to lie on the right is frightened, consistently crying and trying to
side. climb out of the tent. Which is the most
appropriate nursing action?
3. A new parent expresses concern to the nurse
regarding sudden infant death syndrome a. Tell the mother that the child must stay in
(SIDS). She asks the nurse how to position her the tent.
new infant for sleep. In which position should b. Place a toy in the tent to make the child feel
the nurse tell the parent to place the infant? more comfortable.
c. Call the health care provider and obtain a
a. Side or prone prescription for a mild sedative.
b. Back or prone d. Let the mother hold the child and direct
c. Stomach with the face turned the cool mist over the child’s face.
d. Back rather than on the stomach
7. The clinic nurse reads the results of a
4. The clinic nurse is providing instructions to tuberculin skin test (TST) on a 3-year-old
a parent of a child with cystic fibrosis child. The results indicate an area of induration
regarding the immunization schedule for the measuring 10 mm. The nurse should interpret
child. Which statement should the nurse make these results as which finding?
to the parent?
a. Positive
a. “The immunization schedule will need to be b. Negative
altered.” c. Inconclusive
d. Definitive and requiring a repeat test f. Ensure that nurses caring for the infant
8. The mother of a hospitalized 2-year-old with RSV do not care for other high-risk
child with viral laryngotracheobronchitis children.
(croup) asks the nurse why the health care
provider did not prescribe antibiotics. Which
response should the nurse make?

a. “The child may be allergic to antibiotics.”

b. “The child is too young to receive
antibiotics.”
c. “Antibiotics are not indicated unless a
bacterial infection is present.”
d. “The child still has the maternal antibodies
from birth and does not need antibiotics.”

9. The nurse is caring for an infant with

bronchiolitis, and diagnostic tests have
confirmed respiratory syncytial virus (RSV).
On the basis of this finding, which is the most
appropriate nursing action?

a. Initiate strict enteric precautions.

b. Move the infant to a room with another
child with RSV.
c. Leave the infant in the present room because
RSV is not contagious.
d. Inform the staff that they must wear a mask,
gloves, and a gown when caring for the child.

10. The nurse is preparing for the admission of

an infant with a diagnosis of bronchiolitis
caused by CHAPTER 39 Respiratory
Disorders 475 respiratory syncytial virus
(RSV). Which interventions should the nurse
include in the plan of care? Select all that
apply.

a. Place the infant in a private room.

b. Ensure that the infant’s head is in a flexed
position.
c. Wear a mask at all times when in contact
with the infant.
d. Place the infant in a tent that delivers warm
humidified air.
e. Position the infant on the side, with the head
lower than the chest.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. The nurse is closely monitoring the intake
CARDIOVASCULAR DISORDERS and output of an infant with heart failure who
is receiving diuretic therapy. The nurse should
1. The nurse is monitoring an infant with use which most appropriate method to assess
congenital heart disease closely for signs of the urine output?
heart failure (HF). The nurse should assess the
infant for which early sign of HF? a. Weighing the diapers
b. Inserting a urinary catheter
a. Pallor c. Comparing intake with output
b. Cough d. Measuring the amount of water added to
c. Tachycardia formula
d. Slow and shallow breathing
6. The clinic nurse reviews the record of a
2. The nurse reviews the laboratory results for child just seen by a health care provider and
a child with a suspected diagnosis of diagnosed with suspected aortic stenosis. The
rheumatic fever, knowing that which nurse expects to note documentation of which
laboratory study would assist in confirming the clinical manifestation specifically found in this
diagnosis? disorder?

a. Immunoglobulin a. Pallor
b. Red blood cell count b. Hyperactivity
c. White blood cell count c. Exercise intolerance
d. Anti–streptolysin O titer d. Gastrointestinal disturbances

3. On assessment of a child admitted with a 7. The nurse has provided home care
diagnosis of acute-stage Kawasaki disease, the instructions to the parents of a child who is
nurse expects to note which clinical being discharged after cardiac surgery. Which
manifestation of the acute stage of the disease? statement made by the parents indicates a need
for further instruction?
a. Cracked lips
b. Normal appearance a. “A balance of rest and exercise is
c. Conjunctival hyperemia important.”
d. Desquamation of the skin b. “I can apply lotion or powder to the
incision if it is itchy.”
4. The nurse provides home care instructions c. “Activities in which my child could fall
to the parents of a child with heart failure need to be avoided for 2 to 4 weeks.”
regarding the procedure for administration of d. “Large crowds of people need to be avoided
digoxin. Which statement made by the parent for at least 2 weeks after surgery.”
indicates the need for further instruction?
8. A child with rheumatic fever will be
a. “I will not mix the medication with food.” arriving to the nursing unit for admission. On
b. “I will take my child’s pulse before admission assessment, the nurse should ask the
administering the medication.” parents which question to elicit assessment
c. “If more than 1 dose is missed, I will call information specific to the development of
the health care provider.” rheumatic fever?
d. “If my child vomits after medication
administration, I will repeat the dose.” a. “Has the child complained of back pain?”
b. “Has the child complained of headaches?”
c. “Has the child had any nausea or vomiting?” ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
d. “Did the child have a sore throat or fever RENAL & URINARY DISORDERS
within the last 2 months?”
1. The nurse reviews the record of a child who
9. A health care provider has prescribed is suspected to have glomerulonephritis.
oxygen as needed for an infant with heart Which statement by the child’s parent should
failure. In which situation should the nurse the nurse expect that is associated with this
administer the oxygen to the infant? diagnosis?

a. During sleep a. “I’m so glad they didn’t find any protein in

b. When changing the infant’s diapers his urine.”
c. When the mother is holding the infant b. “I noticed his urine was the color of
d. When drawing blood for electrolyte level coca-cola lately.”
testing c. “His health care provider said his kidneys
are working well.”
10. Assessment findings of an infant admitted d. “The nurse who admitted my child said his
to the hospital reveal a machinery-like murmur blood pressure was low.”
on auscultation of the heart and signs of heart
failure. The nurse reviews congenital cardiac 2. The nurse performing an admission
anomalies and identifies the infant’s condition assessment on a 2-year-old child who has been
as which disorder? diagnosed with nephrotic syndrome notes that
which most common characteristic is
a. Aortic stenosis associated with this syndrome?
b. Atrial septal defect
c. Patent ductus arteriosus a. Hypertension
d. Ventricular septal defect b. Generalized edema
c. Increased urinary output
d. Frank, bright red blood in the urine

3. The nurse is planning care for a child with

hemolytic-uremic syndrome who has been
anuric and will be receiving peritoneal dialysis
treatment. The nurse should plan to implement
which measure?

a. Restrict fluids as prescribed.

b. Care for the arteriovenous fistula.
c. Encourage foods high in potassium.
d. Administer analgesics as prescribed.

4. A 7-year-old child is seen in a clinic, and

the health care provider documents a diagnosis
of primary nocturnal enuresis. The nurse
should provide which information to the
parents?

a. Primary nocturnal enuresis does not respond

to treatment.
b. Primary nocturnal enuresis is caused by a
psychiatric problem. 8. Which question should the nurse ask the
c. Primary nocturnal enuresis requires surgical parents of a child suspected of having
intervention to improve the problem. glomerulonephritis?
d. Primary nocturnal enuresis is usually
outgrown without therapeutic intervention. a. “Did your child fall off a bike onto the
handlebars?”
5. The nurse provided discharge instructions to b. “Has the child had persistent nausea and
the parents of a 2-year-old child who had an vomiting?”
orchiopexy to correct cryptorchidism. Which c. “Has the child been itching or had a rash
statement by the parents indicates the need for anytime in the last week?”
further instruction? d. “Has the child had a sore throat or a
throat infection in the last few weeks?”
a. “I’ll check his temperature.”
b. “I’ll give him medication so he’ll be 9. The nurse collects a urine specimen
comfortable.” preoperatively from a child with epispadias
c. “I’ll check his voiding to be sure there’s no who is scheduled for surgical repair. When
problem.” analyzing the results of the urinalysis, which
d. “I’ll let him decide when to return to his should the nurse most likely expect to note?
play activities.”
a. Hematuria
6. The nurse is reviewing a treatment plan with b. Proteinuria
the parents of a newborn with hypospadias. c. Bacteriuria
Which statement by the parents indicates their d. Glucosuria
understanding of the plan?
10. The nurse is performing an assessment on
a. “Caution should be used when straddling the a child admitted to the hospital with a probable
infant on a hip.” diagnosis of nephrotic syndrome. Which
b. “Vital signs should be taken daily to check assessment findings should the nurse expect to
for bladder infection.” observe? Select all that apply.
c. “Catheterization will be necessary when the
infant does not void.” a. Pallor
d. “Circumcision has been delayed to save b. Edema
tissue for surgical repair.” c. Anorexia
d. Proteinuria
7. The nurse is caring for an infant with a e. Weight loss
diagnosis of bladder exstrophy. To protect the f. Decreased serum lipids
exposed bladder tissue, the nurse should plan
which intervention?

a. Cover the bladder with petroleum jelly

gauze.
b. Cover the bladder with a nonadhering
plastic wrap.
c. Apply sterile distilled water dressings over
the bladder mucosa.
d. Keep the bladder tissue dry by covering it
with dry sterile gauze.
~~~~~~~~~~~~~~~~~~~~~~~~~~~
NEUROLOGICAL DISORDERS a. Obtain daily weight.
b. Provide clear liquid intake.
1. The parents of a child recently diagnosed c. Nasotracheal suction as needed.
with cerebral palsy ask the nurse about the d. Maintain a patent intravenous line.
limitations of the disorder. The nurse responds
by explaining that the limitations occur as a 5. The nurse is reviewing the record of a child
result of which pathophysiological process? with increased intracranial pressure and notes
that the child has exhibited signs of
a. An infectious disease ofthe central decerebrate posturing. On assessment of the
nervoussystem child, the nurse expects to note which
b. An inflammation of the brain as a result of a characteristic of this type of posturing?
viral illness
c. A chronic disability characterized by a. Flaccid paralysis of all extremities
impaired muscle movement and posture b. Adduction of the arms at the shoulders
d. A congenital condition that results in c. Rigid extension and pronation of the
moderate to severe intellectual disabilities arms and legs
d. Abnormal flexion of the upper extremities
2. The nurse notes documentation that a child and extension and adduction ofthe lower
is exhibiting an inability to flex the leg when extremities
the thigh is flexed anteriorly at the hip. Which
condition does the nurse suspect? 6. A child is diagnosed with Reye’s syndrome.
The nurse creates a nursing care plan for the
a. Meningitis child and should include which intervention in
b. Spinal cord injury the plan?
c. Intracranial bleeding
d. Decreased cerebral blood flow a. Assessing hearing loss
b. Monitoring urine output
3. A mother arrives at the emergency c. Changing body position every 2 hours
department with her 5-year-old child and states d. Providing a quiet atmosphere with
that the child fell off a bunk bed. A head injury dimmed lighting
is suspected. The nurse 506 UNIT VII
Pediatric Nursing checks the child’s airway 7. The nurse creates a plan of care for a child
status and assesses the child for early and late at risk for tonic-clonic seizures. In the plan of
signs of increased intracranial pressure (ICP). care, the nurse identifies seizure precautions
Which is a late sign of increased ICP? and documents that which item(s) need to be
placed at the child’s bedside?
a.. Nausea
b. Irritability a. Emergency cart
c. Headache b. Tracheotomy set
d. Bradycardia c. Padded tongue blade
d. Suctioning equipment and oxygen
4. The nurse is assigned to care for an
8-year-old child with a diagnosis of a basilar 8. A lumbar puncture is performed on a child
skull fracture. The nurse reviews the health suspected to have bacterial meningitis, and
care provider’s (HCP’s) prescriptions and cerebrospinal fluid (CSF) is obtained for
should contact the HCP to question which analysis. The nurse reviews the results of the
prescription?
CSF analysis and determines that which results
would verify the diagnosis?

a. Clear CSF, decreased pressure, and elevated

protein level
b. Clear CSF, elevated protein, and decreased
glucose levels
c. Cloudy CSF, elevated protein, and
decreased glucose levels
d. Cloudy CSF, decreased protein, and
decreased glucose levels

9. The nurse is planning care for a child with

acute bacterial meningitis. Based on the mode
of transmission of this infection, which
precautionary intervention should be included
in the plan of care?

a. Maintain enteric precautions.

b. Maintain neutropenic precautions.
c. No precautions are required as long as
antibiotics have been started.
d. Maintain respiratory isolation
precautions for at least 24 hours after the
initiation of antibiotics.

10. An infant with a diagnosis of

hydrocephalus is scheduled for surgery. Which
is the priority nursing intervention in the
preoperative period?

a. Test the urine for protein.

b. Reposition the infant frequently.
c. Provide a stimulating environment.
d. Assess blood pressure every 15 minutes.

11. The nurse is creating a plan of care for a

child who is at risk for seizures. Which
interventions apply if the child has a seizure?
Select all that apply.

a. Time the seizure.

b. Restrain the child.
c. Stay with the child.
d. Place the child in a prone position.
e. Move furniture away from the child.
f. Insert a padded tongue blade in the child’s
mouth.